PubMed · 4494954
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M Turner. 1974-05-31. Obstructed labour.. https://pubmed.ncbi.nlm.nih.gov/4494954/
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A trial of labor after a previous low transverse cesarean section in the absence of ongoing contraindications is safe for most women. A comprehensive review and meta-analysis of the literature was conducted to determine outcomes, costs and women's preferences by method of delivery. About seven of 10 women who undergo a trial of labor after previous low transverse cesarean section can expect to deliver vaginally. The following differences in absolute risks were identified: a trial of labor was associated with a slightly increased risk of uterine rupture (0.24 percent) and a decreased risk of infection and fever (5.2 percent) and postpartum bleeding (0.59 percent) as compared with an elective repeat cesarean section. The difference in risk for newborns with an Apgar score of less than 7 at five minutes was 0.85 percent for infants delivered vaginally after a trial of labor versus infants delivered by elective repeat cesarean section. Financial cost (as measured by hospital charges) of cesarean delivery was 1.66 to 2.4 times greater than the cost of vaginal birth. This difference was due almost entirely to the longer length of hospital stay for women who had a cesarean delivery. When given the opportunity, about two-thirds of eligible women choose a trial of labor over elective repeat cesarean section. The reasons underlying women's preferences for a trial of labor or elective repeat cesarean section were diverse and changed during pregnancy. As a consequence, women's preferences for the method of delivery must be explored and respected throughout pregnancy and during the delivery process.(ABSTRACT TRUNCATED AT 250 WORDS)
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A supersonic study of the lower uterine segment of pregnant women which have had a Caesarean operation in the past has been made. The aim of this study is the confirmation of the supersonic scanning as a part of the struggle for diminution of the second abdominal deliveries. Twenty-six pregnant women with anamnesis of Caesarean operation were observed. The following conditions have been kept: precise probable term of delivery, gestational period--35-37 g.w., one foetus in head position, unspoiled amniotic fluid and full urinary bladder. It is obligatory a longitudinal and cross scanning in the area of the cicatrix to be made. For the assessment of the cicatrix sufficiency the author has applied supersonic criteria known in the literature. They include: shape, thickness, incessancy, outside lines and echo structure of the lower uterine segment. The results show: the scar is sufficient in 24 women--it has a triangular form in the lower uterine segment, even outside lines, the thickness of the cicatrix is above 3-5 mm it is incessant and with homogeneous echo structure. In 2 of th pregnant women there are data for inadequacy-the form is like a balloon, the cicatrix has got thinner under 3 mm, the incessancy of the lower segment is absent-it is with defects and uneven outside lines, the echo structure is heterogeneous with predominance of increased echogenicity. According to the way of delivery the results are confirmed pathohistologically, by microscope or by manual palpation. The effectiveness of the supersonic assessment of the cicatrix has been shown.